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Tuesday, July 23, 2024

PhilHealth tries front-loading Konsulta funds

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The Philippine Health Insurance Corporation (PhilHealth) will pilot-test the frontloading of funds instead of the usual reimbursement scheme to the first seven primary care networks that will be established across the country.

PhilHealth on Monday formalized its partnership with five local government units and two private sector groups to form a Primary Care Provider Network (PCPN).

Under the existing setup, PhilHealth’s Konsultasyong Sulit at Tama (Konsulta) primary care benefit package covers patient consultations, any of 13 laboratory and diagnostic tests as ordered by the doctor, and 21 common medications that can be prescribed according to their medical needs.

Konsulta providers are then paid, on the average, P500 to P750 per patient per year on a reimbursement basis after services have been rendered.

But with the PCPN under the Universal Health Care (UHC) Act, funds will now be frontloaded.

The seven Konsulta PCPNs cover around 2 million individuals from Bataan, Guimaras, Quezon, South Cotabato, and Baguio City.

At least 300,000 more Filipinos who are under the care of the LiFE group as well as QualiMed would also benefit from the new financing scheme.

The first PCPNs are projected to be paid a total of P1.2 billion which may be used to improve infrastructure, equipment, and staff compensation even before the first patient starts using services.

“Primary care and essential public health services, integrated with a broader health care network of hospitals and other facilities, is a key element needed for universal health care to happen. Every Filipino should feel the UHC,” Health Secretary Ted Herbosa said.

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